Geris Flashcards
How sensitive and specific is CAM (Confusion Assessment Method)
What does it involve?
94% sensitive, 89% specific
Acute onset, Inattention + either impaired consciousness or disorganised thinking
How to differentiate between delirium and dementia?
Delirium: acute, fluctuating, not orientated, impaired attention
Dementia: insidious onset, progressive, attention normally intact
What does the timed up and go test assess?
Mobility, balance and falls risk
Normal < 10s
Increased risk of falls in community dwelling adults >13.5s
Assesses falls risk
82yo mane presents with difficulty walking due to OA in his right hip. When prescribing a single point stick as a walking aide for him, the most appropriate instruction regarding use of the cane is:
Hold the cane on left hand and advance SPS with right leg - hold SPS in the “good” hand and advance with SPS with the ‘bad” leg
CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarcts and leukenoencephalopathy
lacunar infarct, family history of dementia, dementia at young age, white matter disease, notch 3 gene, chromosome 19
Signs of normal pressure hydrocephalus
Cognitive impairment
Urinary incontinence
Dyspraxic gait
In Lewy Body dementia, what develops first - the dementia or parksinsons?
Dementia occurs first and then parkinsons later
What can help diagnose lewy body dementia?
SPECT scan - sensitivity 90%, specificity 100%
Low dopamine transporter uptake in basal ganglia on SPECT
3 types of frontotemporal lobar degeneration
- Frontotemporal dementia (Pick’s disease)
- Progressive non fluent aphasia (chronic progressive aphasia, CPA)
- Semantic dementia
Name 3 cholinesterase inhibitors use to treated Alzheimers
Donepezil
Rivastigamine
Galantamine
“Dona Riva dances at the nursing home gala:” Donepezil, rivastigmine, and galantamine.
Benefit of cholinesterase inhibitors in Alzheimers
Improve cognitive function and improvement in activities of daily living
Adverse effects of cholinesterase inhibitors
- GIT symptoms: upset stomach, nausea, diarrhoea, anorexia, weight loss occurs in 20-30% of patients
Toxicity dose related, often resolves with time and dose reduction - Bradycardia from cholinergic toxicity
- Headaches
- Sleep disturbances like insomnia, vivid dreams, nightmares(happens with donepezil)
- Can worsen urge incontinence
- rarely rhabdo and NMS
Contraindications of cholinesterase inhibitors
Bradycardia, sick sinus syndrome, heart block, risk of fall/syncope/fractures
Mechanism of action of memantine and SE
NMDA antagonist used for moderate to severe Alzheimers
SE: headaches, dizziness, confusion, hallucinations , seizures
Should not use anticholinergic substances, eg: tricyclic antidepressants
Pathology of AD
- Neuritic plaques (amyloid beta) accumulating extracellularly
- Neurofibrillary tangles (phosphorylated tau) accumulating intracellularly
What infarcts are normally seen in vascular dementia?
Lacunar infarcts
What might be see on the SPECT scan for LBD?
Decreased occipital perfusion/metabolism
Pathology of lewy body dementia
a-synuclein
What might be see on the SPECT scan for frontotemporal dementia
Metabolic disorders in frontal and temporal lobes
What is order of language impairment in AD
naming - comprehension - fluency